Ebola – the long road to recovery

After 10 months, nearly 23,000 cases and over 9,000 deaths, the Ebola virus appears to be loosening its grip on Guinea, Liberia and Sierra Leone.

While some have already begun to hail the ‘end’ of the crisis, celebrations are somewhat premature. The signs are pointing in the right direction, but Ebola has not yet been defeated.

Overall case numbers have been on a downward trend in 2015. However, the past week has seen a sharp rise in infections in Guinea, while in Sierra Leone figures continue to fluctuate, despite a steep decline from December until the end of January.

The World Health Organization warned this week that the ‘spike in cases in Guinea and continued widespread transmission in Sierra Leone underline the considerable challenges that must still be overcome to get to zero cases’.

The road to recovery has indeed begun, but we must guard against complacency. For months to come, we must still count on the possibility of the virus resurfacing. This is particularly true in Sierra Leone, which accounts for half of all cases in the global outbreak.

On a recent visit to Sierra Leone, I saw first-hand the extent to which the country and its people have been affected by the crisis. It will be a long time before the wounds heal – particularly for those who have survived the deadly virus.

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In Sierra Leone, 60 per cent of Ebola victims pulled through, but beating Ebola is not the end of their problems. The challenges they live to face are significant: stigmatization and ostracization; secondary health issues such as weakened eyesight; loss of shelter, income and work; the destruction (through disinfection or burning) of all their belongings and papers; grief at having lost loved ones.

The ensuing emotional turmoil was graphically spelled out to me while shadowing grassroots organizations providing practical help to survivors, with funding from Christian Aid.

Take Issa, for example, a young man I encountered at a survivor support group run by a Christian Aid partner on the outskirts of Freetown.

Issa had been on the edge of death, but survived and was happy to be alive when discharged from the treatment centre. His joy was short-lived. Upon returning to his community he found his house locked up. Every person in his household – all 12 of his relatives – had been killed by the virus. Nobody in the treatment centre had dared to tell him.

Then there was Aminata, a young woman who caught the virus after nursing her sick uncle and aunt, who both died. When she returned to her own home, Aminata’s mother asked her if she’d touched the couple. Aminata said ‘no’, not wanting to upset her mother who was pregnant at the time. The bereaved pair consoled each other. Both mother and daughter subsequently fell ill. Her mother died; Aminata survived. She is now haunted by a sense of guilt over her mother’s death.

There were 25 people in the support group that day. Every person had a story just as harrowing as Issa’s and Aminata’s. These stories are echoed in communities across Sierra Leone, Guinea and Liberia.

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Meanwhile, much has been said about survivors’ immunity to Ebola. What is often absent from these conversations is that the virus can persist in semen for up to three months. Although male survivors are warned to abstain from sexual activity for 90 days, there have been some cases of non-compliance resulting in further transmission.

One male survivor, when asked about this, explained that after enduring the quarantine, the isolation, the absence of any human touch, former Ebola patients find themselves craving affirmation and physical intimacy with their partners. It is devastating to think that the virus is spread by love and affection.

Trauma runs deep, deeper than we can yet imagine, and many post-outbreak recovery efforts will have to be redirected to take account of this.

The work of recovery is a mammoth one. Every sphere of society has been disrupted. Children have missed over eight months of education. The closure of schools is said to have triggered a spike in teenage pregnancies, which will no doubt affect the number of girls attending class once schools finally reopen in March – just as the country was starting to make some progress in girls’ education.

Meanwhile, the health service is on its knees, maternal mortality is on the rise and confidence in the medical establishment is at an all-time low. The strengthening of healthcare systems will lie at the heart of many recovery programmes. And with over 220 Sierra Leonean health workers killed so far by the outbreak, the lack of human resources must now be addressed.

These are infrastructural tasks that cannot be fixed overnight: the road to recovery is a long one. Ultimately, Sierra Leone must be built from the grassroots up. There is a place for help from the outside, but ownership of this recovery process must lie with Sierra Leone and its people.